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Aortocoronary vein graft spasm during angiography
H Kafka1, G M FitzGibbon, A J Leach
1Cardio-Pulmonary Unit, National Defence Medical Centre, Ottawa, Ontario.
Objective:
To determine the frequency and clinical significance of aorto-coronary vein graft spasm during angiography.
Design:
Retrospective review of angiograms and subsequent correlation with clinical outcome.
Patients:
A total of 1264 patients having bypass surgery between 1971 and 1986.
Main Results:
Twenty-four men, aged 31 to 54 years, demonstrated spasm in 31 vein grafts at angiography. Vein graft spasm occurred in 13 anterior descending, 12 right coronary, four marginocircumflex and two diagonal grafts. Spasm occurred less than six months after surgery in six cases, six to 12 months after surgery in 18 cases and five or more years after surgery in two cases. There was technical difficulty associated with the intubation of 15 of the 31 grafts. In all but two of the cases, the graft spasm was proximal. There was ischemic discomfort and/or electrocardiographic changes in nine patients, with ventricular fibrillation in three cases. Three cases of very severe vein graft spasm could be reversed with vasodilators, but in three others it could not be relieved and the grafts occluded irreversibly, leading to myocardial infarction in two patients.
Conclusion:
Aortocoronary vein graft spasm may occur during angiography and may be associated with more technically difficult graft intubation. Severe vein graft spasm may respond to vasodilators but can progress to graft occlusion with myocardial infarction. Aortocoronary vein graft spasm during angiography is not related to any higher incidence of spontaneous graft closure or recurrent angina.